Artikel
End-of-life care preferences of older patients with multimorbidity: a mixed-methods systematic review
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Autoren
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Ana Isabel Gonzalez-Gonzalez
- Goethe University, Institute of General Practice, Germany; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
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Christine Schmucker
- University of Freiburg, Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center-University of Freiburg, Freiburg, Germany
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Julia Nothacker
- University of Freiburg, Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center-University of Freiburg, Freiburg, Germany
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Edris Nury
- University of Freiburg, Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center-University of Freiburg, Freiburg, Germany
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Truc Sophia Dinh
- Goethe University, Institute of General Practice, Germany
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Maria-Sophie Brueckle
- Goethe University, Institute of General Practice, Germany
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Jeanet Wilhelmina Blom
- Leiden University Medical Center, Department of Public Health and Primary Care, Leiden, Netherlands
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Kristian Röttger
- Federal Joint Committee, Patient representative, Germany
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Odette Wegwarth
- Max Planck-Institute for Human Development, Center for Adaptative Rationality, Germany
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Tammy Hoffmann
- Bond University, Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Australia
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Ferdinand M. Gerlach
- Goethe University, Institute of General Practice, Germany
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Sharon Straus
- University of Toronto, Department of Medicine, Toronto, Canada
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Marjan van den Akker
- Goethe University, Institute of General Practice, Germany
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Joerg J. Meerpohl
- University of Freiburg, Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center-University of Freiburg, Freiburg, Germany
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Christiane Muth
- University of Bielefeld, Department of General Practice and Family Medicine, Medical Faculty OWL, Bielefeld, Deutschland; Goethe University, Institute of General Practice, Germany
| Veröffentlicht: | 23. Februar 2021 |
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Gliederung
Text
Background/research question: The unpredictable disease trajectories of older patients with multimorbidity require earlier patient-clinician communication regarding preferences for end-of-life (EoL) care. To offer support to clinicians and assist this patient population, we aimed to conduct a mixed-methods systematic review of primary research assessing EoL care preferences of older patients with multimorbidity.
Methods: We included primary studies (quantitative/qualitative/mixed methods) assessing EoL care preferences of older patients with ≥2 chronic conditions. We systematically searched seven electronic databases. Two independent reviewers screened title/abstracts/full texts, extracted data, and assessed risk of bias using the Mixed Methods Appraisal Tool. We synthesized findings narratively and, if possible, quantitatively.
Results: Twenty studies were included comprising 2,479 patients. All used observational designs except for one quasi-experimental study: three (15%) qualitative, 14 (70%) quantitative, two (10%) mixed methods. The setting was outpatient care in 90%. Eighteen studies (90%) assessed interest in receiving life-sustaining treatments (LSTs), five (25%) the preferred site of death, and eight (40%) preferences for EoL care shared decision-making participation. In four studies, any LST option was preferred by 21% (95% CI 15–29%) of patients when the LST type was not specified. In another three studies, the proportion of patients choosing LST i) decreased as death, the functional or cognitive decline became more likely and ii) increased with potential life extension following treatment. Overall, 67% (95% CI 46–83%) and 48% (95% CI 21–76%) of patients from 13 studies were interested in receiving LSTs such as cardiopulmonary resuscitation/mechanical ventilation under current health circumstances respectively, but the willingness decreased when presented with deteriorating health scenarios. Half (95% CI 45–56%) of the patients from three studies preferred to die at home, however, in one study 61% of patients changed their preference at a one-year follow-up. Seven studies showed most patients prefer not to delegate decisions regarding their own EoL care unless incapacitated. Most studies (15;75%) scored low in quality assessment mostly due to high non-response bias.
Conclusion: By understanding the EoL care preferences of older patients with multimorbidity clinicians may ensure that the care this population receives is concordant with the care they desire.
Competing interests: The authors declare no conflict of interest. The funder had no role in the design of the study, in the collection, analyses, or interpretation of data.
